Abstract

Background and aim: Complications and resistance to pentavalent antimonial agents in cutaneous leishmaniasis, exhibit the need for effective alternative drugs. The aim of this study was to compare the efficacy of oral azithromycin with systemic meglumine antimoniate (Glucantime) in the treatment of cutaneous ...
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Background and aim: Complications and resistance to pentavalent antimonial agents in cutaneous leishmaniasis, exhibit the need for effective alternative drugs. The aim of this study was to compare the efficacy of oral azithromycin with systemic meglumine antimoniate (Glucantime) in the treatment of cutaneous leishmaniasis. Materials and Methods: Forty-seven patients with cutaneous leishmaniasis visited at the dermatology department of Qaem hospital were randomly divided to two groups. Twenty patients (with 29 lesions) were treated with oral azithromycin 500 mg/day for 5 successive days each month for 4 months and 27 patients (with 58 lesions) were treated with systemic Glucantime 60 mg/kg/day for 20 days. Azithromycin group patients were visited monthly and control group patients were visited in last day of treatment and 45 days later. Results:At the end of our study 10.3% of lesions in azithromycin group showed complete response, 27.6% lesions partial response and 62.1% no response. In Glucantime group 34.5% of lesions showed complete response, 13.8% partial response and 51.7% no response (P=0.036).Conclusion: In treatment of cutaneous leishmaniasis systemic Glucantime is superior to oral azithromycin. Differences between our result and previous studies may be due to difference between strains of Leishmanias and in vitro studies may be necessary to resolve this paradox. On the other hand, change in dosage and course of treatment with azithromycin may affect the efficacy of this agent.

Abstract

Background and aim: Solar lentigines are common sun-induced benign melanocytic proliferations that present a significant cosmetic problem for many middle- aged and elderly patients. The purpose of this study was to assess the efficacy of cryotherapy in comparison to trichloroacetic acid (TCA) 33% on ...
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Background and aim: Solar lentigines are common sun-induced benign melanocytic proliferations that present a significant cosmetic problem for many middle- aged and elderly patients. The purpose of this study was to assess the efficacy of cryotherapy in comparison to trichloroacetic acid (TCA) 33% on solar lentigines on the back of the hands (SLBH).Materials and Methods: Each hand of 33 patients with SLBH was treated randomly with either cryotherapy or TCA 33% solution. Photographs of the hands were taken prior to and two months following the treatment. Therapeutic response and side-effect were compared using chi-square test.Results: Twenty five patients completed the study. Cryotherapy was more likely to produce substantial lightening of the solar lentigines than TCA 33% solution (P=0.025) but was more painful and took longer to heal. Post inflammatory hyperpigmentation (PIH) was almost equal in two types of treatment. Statistically, better results were seen in lower Fitzpatrick's skin types (P<0.01).Conclusion: Cryotherapy appears to be superior to TCA 33% solution in the treatment of SLBH particularly in lower Fitzpatrick skin types. PIH is the major complication of both particularly in higher Fitzpatrick skin types. Generally, the major criterion for treatment of SLBH with cryotherapy or TCA is Fitzpatrick's skin type.

Abstract

Background and aim: Warts are the most common clinical presentation of human papilloma virus infection of human skin and mucosa. They are more common on hand, foot, face and genital area. They are benign skin colour lesions with different clinical forms. There is no specific treatment for them. In this ...
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Background and aim: Warts are the most common clinical presentation of human papilloma virus infection of human skin and mucosa. They are more common on hand, foot, face and genital area. They are benign skin colour lesions with different clinical forms. There is no specific treatment for them. In this trial the therapeutic effect of intralesional injection of bleomycin and cryotherapy on common warts of hands and feet was compared.Materials and Methods: Fifty-two subjects entered the study but 44 patients completed the trial. Warts were treated by intralesional injection of bleomycin 0.5 mg/ml or liquid nitrogen on symmetric aspects of both hands and feet. We used cryo-spray gun for application of liquid nitrogen. Treatment was repeated every 2 weeks for a maximum of three times. Treatment was done by a dermatologist and treatment response was evaluated by another dermatologist. Collected data were analyzed by SPSS software.Results: In this trial 23 female and 21 male patients were studied. Totally, 253 warts were treated by cryotherapy and 226 warts by intralesional bleomycin. Cure rate was 73.1% for cryotherapy and 87.6% for intralesional bleomycin (P<0.001).Conclusion: Cure rate for intralesional bleomycin was higher than cryotherapy. Intrelesional bleomycin therapy is an effective and safe treatment for common warts.

Abstract

Background and aim: Laser is one of the most recent techniques which has widespread use in the treatment of many skin diseases. This technique has been successfully used to remove unwanted hairs in hirsutism. The aim of this study was to evaluate and compare the efficacy and safety of long-pulsed 755 ...
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Background and aim: Laser is one of the most recent techniques which has widespread use in the treatment of many skin diseases. This technique has been successfully used to remove unwanted hairs in hirsutism. The aim of this study was to evaluate and compare the efficacy and safety of long-pulsed 755 nm alexandrite and long-pulsed 1064 nm Nd: YAG lasers individually and in combination for permanent hair removal. Materials and Methods: This single-blind randomized clinical trial was conducted on 25 patients. They were treated by alexandrite or Nd: YAG or combination of them in 4 sessions with 8 weeks intervals. The treatment was applied on their medial and lateral sides of both legs. All the parameters of the systems were set on the company defaults. Subjects were evaluated 1 and 8 months after completion of the treatment. Hair count was measured by Visiomed device and digital camera photographs every session. To calculate mean hair reduction, the difference between hair count before and after treatment was divided by hair count before treatment. Pain severity, measured by Visual Analogue Scale (VAS), and side effects (bullae, scar and pigmentation changes) were recorded every session. The data were analyzed with ANOVA, post hoc Tukey and chi square tests. Results: Fifteen patients completed the study and 10 patients were excluded due to appearance of bullae in 2 patients and refuse to continue in 8 patients. The mean hair reduction measured by Visiomed 8 months after last treatment was: 61.96 ±21.09, 60.03±23.40 and 68.05±21.23 percent for alexandrite, Nd: YAG and combination therapy, respectively. When digital camera photos were used for measurement of hair reduction these values were 85.99±11.62, 73.60±16.57 and 79.61±18.08 percent, respectively. The differences between the systems were not significant (ANOVA, P>0.05). In paired comparison of the systems, no significant differences were observed either (Tukey test). The incidence of adverse effects (hyperpigmentation) and pain severity were significantly greater in area received combination therapy (P=0.001).Conclusion: Both alexandrite and Nd:YAG laser systems were effective in hair removal. In contrast, combination therapy did not have more efficacy and also caused more side effects.

Abstract

Background and aim: It is possible to use light sources suxh as lasers to destruct melanosomes and treat pigmented skin lesions. One of the most commonly used laser systems is Q switched ruby laser with a wave-length of 694 nm. This study was performed to evaluate the efficacy of the Q switched ruby ...
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Background and aim: It is possible to use light sources suxh as lasers to destruct melanosomes and treat pigmented skin lesions. One of the most commonly used laser systems is Q switched ruby laser with a wave-length of 694 nm. This study was performed to evaluate the efficacy of the Q switched ruby laser in the treatment of pigmented skin lesions including lentigines (simplex or solar) and café-au-lait macules.Materials and Methods: After physical examination for ruling out the possibility of malignancy by two dermatologists, patients were treated with Q switched ruby laser. Response to treatment was categorized in four groups of equal interval according to the 0-100% lesion lightening.Results: Ninetyy patients including 81 patients with solar lentigo and 9 cases of lentigo simplex were recruited into this study. Mean±standard deviation (SD) of the number of treatment sessions for solar lentigo and lentigo simplex cases were 1.0 ± 0.5 and 3.6 ± 1.3 , respectively. Although the mean of sessions was increased in darker skin types, there was no statistically significant difference between different skin types (p=0.335). In addition, there was no significant relation between mean treatment sessions and location of the lesions (p=0.685). Cure rate was 100% in all lentigo cases and after a mean ±SD of 8.7±2.3 months follow up there was no recurrence. Also, there was neither pigmentary change nor folliculitis during treatment. In 7 cases with café-au-lait macules, the mean±SD score of improvement was 2.4 ± 0.8, which was achieved after 3.1±0.4 treatment sessions. In 6 cases whom were followed up for 10.2 ± 3.1 months, despite primary disappearance, recurrence of café-au-lait macules was observed. Conclusion: It seems Q switched ruby laser is an appropriate method for treatment of lentiginous lesions in caucasians with Fitzpatrick's skin types II to IV.

Abstract

Background and aim: Non-melanoma skin cancers (NMSC) are one of the most prevalent malignancies of the human. Although the morality rate is not high for these cancers, they may cause high morbility for the patients. In addition to the skin type, factors such as sun exposure, head and neck radiotherapy, ...
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Background and aim: Non-melanoma skin cancers (NMSC) are one of the most prevalent malignancies of the human. Although the morality rate is not high for these cancers, they may cause high morbility for the patients. In addition to the skin type, factors such as sun exposure, head and neck radiotherapy, inappropriate use of sunscreen and cultural changes may increase the incidence of these cancers. The objective of this study was to determine NMSC in Isfahan.Materials and Methods: We used data of the cancer resistery center for performing this study and the incidence of NMSC per 100,000 papulation was determined.Results: Overall 1681 cases were registered. The incidence of NMSC was calculated to be 10.67/100,000 population. The most common site for BCC and SCC was middle face.Conclusion: NMSC incidence in Isfahan is lower than west countries although this incidence is 10.67/100,000 in a year. It means that 5-6 thousand cases of NMSC occur in Iran each year. We can prevent its morbidity and mortality by early correct diagnosis.

Abstract

Background and aim: Pemphigus vulgaris (PV) is the most common blistering disease in Iran and many other Asian countries with a relatively high incidence and involvement of both skin and mucous membrances in majority of patients. The aim of this study was to assess the opinions of Asian experts on the ...
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Background and aim: Pemphigus vulgaris (PV) is the most common blistering disease in Iran and many other Asian countries with a relatively high incidence and involvement of both skin and mucous membrances in majority of patients. The aim of this study was to assess the opinions of Asian experts on the diagnosis and management of PV. Materials and Methods: A questinnaire-based mailed/emailed survey was conducted. The questionnaire was sent to 29 dermatologists from different countries of Asia (23 from Iran and 6 from India, Kuwait, Turkey and Bangladesh) who are in charge of the treatment of autoimmune blistering disorders with at least 5 years experience in this field who visit at least five new PV patients annually. Questions incluced duration of experience, number of patients treated and diagnostic and treatment approaches for PV. Descriptive data were reported using SPSS 11.5 and some data are reported as mean±SD. Results: All 29 physicians participated in the survey. Among them, 79.3% visit their patients within 6 months after the onset of symptoms. Diagnosis of PV is confirmed by histologic and direct immunofluorescence examinations by 65.5% of physicians. All of them initiate the treatment with corticosteroids (48.3% with a dose of at least 2 mg/kg/day prednisolone) and 89.7% add adjuvant immunosuppressors at the same time. Of the adjuvant agents used, azathioprine is used by 82.8% of physicians. Conclusion: Different trends in diagnostic techniques and treatment options for PV among the experienced authorities emphasize the urgent need for large-scale controlled trials to reach consensus standards in this field. In addition, regional and worldwide consensus meetings to consider all regional and genetic similarities and differences are highly recommended.

Abstract

Background and aim: Skin diseases among pilgrims are considered to be one of the possible health problems. Data supporting this observation are scanty. The aim of this study was to report the most common skin diseases seen in Hajj season. Materials and Methods: Data regarding skin diseases were collected ...
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Background and aim: Skin diseases among pilgrims are considered to be one of the possible health problems. Data supporting this observation are scanty. The aim of this study was to report the most common skin diseases seen in Hajj season. Materials and Methods: Data regarding skin diseases were collected from piligrims whom were examined and diagnosed clinically at the skin clinics of Iran in Saudi Arabia in 1993 and 1999. Results: During the Hajj season in 1999, 362 patients were seen. The most common groups of diseases were eczemas of different types and related conditions (35.9%), mechanical and thermal injury (17.6%) and infections (16.5%), accounted for more than 70% of cases. During Hajj season in 1993, 560 patients were seen. The most common groups of diseases were infections (19.3%), eczema and related conditions (18.6%) and disorders of skin appendages (16.4%), accounted for about 54.2% of observed skin diseases.Conclusion: The finding of these most common skin disorders is important in training programmes and delivery of service for care of pilgrims, because they are preventable, easily diagnosed and curable in the majority of patients.

Abstract

Background and aim: Recurrent aphthous stomatitis is a relapsing disease with typical ulcers that involve the oral mucosa. The objective of this study was to determine the microbial flora and pH of mouth in patients during and between disease relapse.Materials and Methods: Patients were selected by simple ...
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Background and aim: Recurrent aphthous stomatitis is a relapsing disease with typical ulcers that involve the oral mucosa. The objective of this study was to determine the microbial flora and pH of mouth in patients during and between disease relapse.Materials and Methods: Patients were selected by simple non-random sampling. Totally 28 patients were included in this study. After filling out a questionnarie, patients were referred to the laboratory and a sample from oral ulcer was obtained and cultured in both aerobic and anaerobic media. PH of mouth was measured by pH meter. Same process was repeated two weeks after remission.Results: Considering non-group A Streptococci and gram positive bacteria, there were no changes in oral flora culture in aerobic environment in relapse and remission time. Staphylococcus aureus growth was seen in aerobic environment in 3(10.7%) patients in relapse and in 2 (7.1%) in remission which was not statistically significant. There were not considerable changes in group A Streptococci in remission and relapses and also in gram negative bacilli. But in anaerobic cultures there was considerable increase of non-group A Streptococcus in relapse and remission (71/4%, in relapse and 39.3% in remission, P<0.01). There were not specific changes in other bacteria. There was higher oral pH in 53.3% of patients, lower pH in 20% and no change in pH in 26.7% of patients during active phase of disease.Conclusion:There is considerable increase in non-A Streptococcus and increasing oral pH in majority of patients with aphthous stomatitis in relapse time.

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory joint disease with different extra-articular manifestations. Among those extra-articular manifestations, there are significant cutaneous manifestations which may result in first admission to a dermatologist. In this article some specific and non-specific ...
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Rheumatoid arthritis (RA) is a chronic inflammatory joint disease with different extra-articular manifestations. Among those extra-articular manifestations, there are significant cutaneous manifestations which may result in first admission to a dermatologist. In this article some specific and non-specific skin lesions of RA such as rheumatoid nodules, exacerbated nodules, rheumatoid vasculitis, Bywaters, pyoderma gangrenosum and neutrophilic rheumatoid dermatoses are discussed. Some of these lesions such as rheumatoid nodules are very common and some others are very rare.

Abstract

The Proteus syndrome comprises an association of asymmetrical overgrowth of almost any part of the body, verrucous epidermal naevi, vascular malformations and lipoma-like subcutaneous hamartoma. Both sexes are affected with equal frequency and severity and it is not transmitted genetically. Here a 16-year-old ...
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The Proteus syndrome comprises an association of asymmetrical overgrowth of almost any part of the body, verrucous epidermal naevi, vascular malformations and lipoma-like subcutaneous hamartoma. Both sexes are affected with equal frequency and severity and it is not transmitted genetically. Here a 16-year-old man with asymmetric overgrowth of the extremities, macrodactyly, cerebriform hypertrophy of the soles and various skin and bony lesions is reported diagnosed as Proteus syndrome.